血清BUN/Cr、cTnI、NTpro-BNP在老年急性左心衰竭患者病情评估及预后预测中的价值  

Value of serum BUN/Cr,cTnI and NTpro-BNP in the assessment and prognosis of senile patients with acute left heart failure

作　　者：朱琤磊 蒯正平 杨伟伟 朱伟俊 ZHU Zhenglei;KUAI Zhengping;YANG Weiwei;ZHU Weijun(Shanghai Hongkou District Jiangwan Hospital,Shanghai 200080,China;不详)

机构地区：[1]上海市虹口区江湾医院,上海200080 [2]上海市静安区闸北中心医院,上海200040

出　　处：《中国急救复苏与灾害医学杂志》2023年第8期985-989,共5页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：上海市卫生系统优秀青年医学人才培养项目(编号:PWRq2018-99)。

摘　　要：目的探究血清血尿素氮/肌酐(BUN/Cr)、肌钙蛋白I(cTnI)、N末端B型钠尿肽原前体(NTpro-BNP)在老年急性左心衰竭患者病情评估及预后预测中的价值。方法选取上海市虹口区江湾医院2020年8月—2022年3月102例老年急性左心衰竭患者,根据急性生理学及慢性健康状况Ⅱ(APACHEⅡ)评分分为非危重组(<20分,37例)、危重组(20~30分,33例)、极危重组(>30分,32例)。比较三组血清BUN/Cr、cTnI、NTpro-BNP水平,分析血清BUN/Cr、cTnI、NTpro-BNP与病情程度的关系,统计三组出院后随访30 d预后情况,分析BUN/Cr、cTnI、NTpro-BNP与不同病情程度患者预后的关系及预测价值。结果极危重组血清BUN/Cr、cTnI、NTpro-BNP水平高于危重组、非危重组,危重组高于非危重组(P<0.05);BUN/Cr、cTnI、NTpro-BNP与病情程度呈正相关(P<0.05);出院后随访30 d,极危重组心血管终点事件发生率高于危重组、非危重组(P<0.05);三组发生心血管终点事件患者血清BUN/Cr、cTnI、NTpro-BNP水平均高于未发生心血管终点事件患者(P<0.05),血清BUN/Cr、cTnI、NTpro-BNP与心血管终点事件呈正相关(P<0.05);ROC曲线分析,血清BUN/Cr、cTnI、NTpro-BNP联合预测非危重、危重、极危重患者发生心血管终点事件的AUC分别为0.871(95%CI:0.750~0.992)、0.855(95%CI:0.720~0.992)、0.884(95%CI:0.771~0.995),均高于三者单独预测价值。结论血清BUN/Cr、cTnI、NTpro-BNP与老年急性左心衰竭病情显著相关,能为病情评估提供依据,联合检测还可作为预测不同病情程度患者预后的有效途径。Objective To explore blood urea nitrogen/creatinine(BUN/Cr),cardiac tropnin I of(cTnI)and N-terminal Btype natriuretic peptide precursor(NTpro-BNP)in the assessment and prognosis in elderly patients with acute left heart failure.Methods A total of 102 elderly patients with acute left heart failure were selected from Jiangwan Hospital of Hongkou District of Shanghai from August 2020 to March 2022.According to acute physiology and chronic health evaluationⅡ(APACHEⅡ)they were divided to non-critical group(<20 points,37 cases),critical group(20-30 points,33 cases),and extremely critical group(>30 points,32 cases).The serum BUN/Cr,cTnI and NTpro-BNP levels of the three groups were compared,and the relationship between serum BUN/Cr,cTnI and NTpro-BNP and the severity of this disease was analyzed.The prognosis of the three groups was statistically analyzed after 30 days of follow-up after discharge.The relationship between BUN/Cr,cTnI,NTpro-BNP and prognosis of patients with different disease degrees and their predictive value was analyzed.Results The levels of BUN/Cr,cTnI and NTpro-BNP in extremely critically ill group were higher than those in critically ill group and non-critically ill group,and critically ill group was higher than those in non-critically ill group(P<0.05).BUN/Cr,cTnI and NTpro-BNP were positively correlated with the severity of the disease(P<0.05).At 30 days of follow-up after discharge,the incidence of cardiovascular end events in extremely critical group was higher than that in the critical and non-critical groups(P<0.05).Serum BUN/Cr,cTnI and NTpro-BNP levels in patients with cardiovascular end events in 3 groups were higher than those in patients without cardiovascular end events(P<0.05),and serum BUN/Cr,cTnI and NTpro-BNP were positively correlated with cardiovascular end events(P<0.05).ROC curve analysis showed that the combined prediction AUCs of serum BUN/Cr,cTnI and NTpro-BNP for cardiovascular end events in non-critical,critical and extremely critical patients were 0.871(95%CI:0.750-0.

关 键 词：老年 急性左心衰竭 血尿素氮 肌酐 肌钙蛋白I N末端B型钠尿肽原前体 

分 类 号：R541.6[医药卫生—心血管疾病]